To declare the clinical value of lowing serum LDL-C level in coronary heart disease by reviewing the history of its clinical trials in the last 4 decades.
ObjectiveTo evaluate the relationship between low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) of preoperation (L/H value for short) and the pathological staging of colorectal cancer. MethodsThe clinical data of 187 patients with colorectal cancer who treated in PLA General Hospital from July 2009 to June 2014 were analyzed retrospectively. ResultsThere were statistical significance in L/H value among different TNM stagings, N stagings, and M stagings (P<0.05):L/H value of TNM Ⅳ staging was higher than those of TNM Ⅰ, Ⅱ, and Ⅲ staging, L/H values of N1 staging and N0 staging were lower than that of N2 staging, L/H value of M1 staging was higher than that of M0 staging. However, there was no statistical significance in L/H value among different T stagings of colorectal cancer (P>0.05). Logistic regression results showed that L/H value were positively associated with TNM staging (OR=4.34, 95% CI:2.837-6.644, P<0.000 1), T staging (OR=1.72, 95% CI:1.175-2.512, P=0.005 3), N staging (OR=2.15, 95% CI:1.422-3.254, P=0.000 3), and M staging (OR=3.04, 95% CI:1.733-5.332, P=0.000 1) of colorectal cancer, and patient with higher L/H value took more risk of progression of tumor, lymph node metastases, and distant metastasis. ConclusionsRaise of preoperative L/H value is an independent risk factor for the progression of TNM staging, T staging, N staging, and M staging in colorectal cancer.
Objective To investigate the efficacy of LDL-C lowering treatment on NSTE-ACS, and to analyze the target LDL-C level for clinical treatment. Methods PubMed, EMbase, the Cochrane Central Register of Controlled Trials, Web of Science databases were searched up to January 2016 for randomized controlled trials assessing the effects of LDL-C lowering therapy on major adverse cardiac events (MACE) in patients with NSTE-ACS. Two reviewers independently screened litertures, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using Stata12.0 and RevMan 5.3 software. Result A total of 12 RCT including 4 702 individuals with NATE-ACS were included. The results of meta-analysis showed that, compared with the control group, the statin group could significantly reduced the risk of MACE (RR=0.68, 95% CI 0.549 to 0.834,P=0.000). With 18.68 months of follow-up, patients in target LDL-C level from over 70 mg/dL to less than 100 mg/dL group had lower risk of MACE than other LDL-C level group. When LDL-C lower 20% to 40% than baseline with 28.99 months follow-up, patients in target of LDL-C level from over 70 mg/dL to less than 100 mg/dL group had lowest risk of MACE (RR=20.143, 95% CI 6.946 to 58.414,P=0.000). Conclusion LDL-C lower treatment can lower the risk of MACE in patients with NSTE-ACS. Patients in target LDL-C level from over 70 mg/dL to less than 100 mg/dL group have relatively low risk of MACE, in which patients who lower 20% to 40% LDL-C than baseline will get more benefits from LDL-C lowering therapy.
ObjectiveTo analyze the variation trend of high low density lipoprotein cholesterol (LDL-C) attribution disease burden in China from 1990 to 2019. MethodsThe burden of disease indicators from Global Burden of Disease 2019 (GBD 2019), such as death attributable to high LDL-C, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lost to disability (YLDs) were extracted. The age was standardized using GBD 2019 global standard population, and the trend of rates with the annual percentage change (APC) was analyzed. ResultsFrom 1990 to 2019, the disease burden of high LDL-C increased with age in China. The mortality rate, DALYs rate and YLLs rate of males were higher than those of females, while the YLDs rate of males was lower than that of females. Joinpoint regression results showed that from 1990 to 2019, the high LDL-C attribution mortality rate (APC=3.4%, P<0.05), DALYs rate (APC=2.4%, P<0.05), YLLs rate (APC=2.4%, P<0.05), YLDs rate (APC = 2.9%, P<0.05), the standardized mortality rate (APC=0.8%, P<0.05) and the standardized YLDs rate (APC=0.7%, P<0.05) all increased in China. Regarding age, the mortality rate, DALYs rate and YLLs rate increased in the age group over 70 years old, while the YLDs rate increased significantly in the age group over 45 years old. ConclusionFrom 1990 to 2019, the burden of disease attributable to high LDL-C in China has become increasingly heavy, and the burden varies according to gender and age.
ObjectiveTo understand the current status of low-density lipoprotein cholesterol (LDL-C) control in patients after coronary artery bypass grafting. MethodsClinical data of patients who underwent isolated coronary artery bypass grafting in Beijing Anzhen Hospital in 2023 were collected. All patients returned to our hospital approximately one year after surgery (10-13 months) for a lipid level recheck. We analyzed their LDL-C attainment status and influencing factors. Patients were categorized into two groups based on whether their LDL-C met the target: the LDL-C attainment group and the LDL-C non-attainment group. ResultsThis study included 1456 patients who had undergone coronary artery bypass grafting, including 320 females and 1136 males, with an average age of (61.41±9.12) years. One year post-surgery, 234 patients achieved the LDL-C target, with an attainment rate of 16.07%. The proportion of patients in the LDL-C attainment group who were ultra-high risk (77.35% vs. 92.06%, P＜0.001), female (16.24% vs. 23.08%, P=0.021), and those with comorbid hypertension (55.98% vs. 63.18%, P=0.038) was significantly lower than those in the LDL-C non-attainment group. Additionally, the baseline body mass index (BMI) upon admission in the attainment group [(25.37±3.24) kg/m2 vs. (26.03±3.56) kg/m2, P=0.017], total cholesterol levels [(3.30±0.84) mmol/L vs. (4.01±1.03) mmol/L, P＜0.001], LDL-C [(1.62±0.62) mmol/L vs. (2.25±0.85) mmol/L, P＜0.001], and high-density lipoprotein cholesterol [(0.98±0.26) mmol/L vs. (1.02±0.24) mmol/L, P=0.049] were all lower than in the non-attainment group. Moreover, the lipid-lowering drug usage rate in the attainment group (100.00% vs. 96.24%, P=0.003) and the proportion using two types of drugs together (25.21% vs. 10.72%, P＜0.001) were both higher than in the non-attainment group, while the statin monotherapy rate was lower than in the non-attainment group (74.79% vs. 85.19%, P＜0.001). Logistic regression analysis showed that baseline BMI (OR=0.928, P=0.012) and baseline LDL-C levels (OR=0.207, P<0.001), patient cardiovascular risk stratification (OR=0.155, P<0.001) and lipid-lowering drug treatment regimen (OR=3.758, P<0.001) are significant factors affecting whether LDL-C meets the standard. ConclusionThe LDL-C compliance rate of patients undergoing coronary artery bypass grafting is at a relatively low level 1 year after surgery. Patients with very high risk of atherosclerotic cardiovascular disease, high baseline LDL-C levels, and overweight or obesity should strengthen their lipid management. For these patients, the intensity of lipid-lowering drug use or combination medication should be increased upon discharge.